Provider Demographics
NPI:1801763354
Name:OSMAN, MUKTAR A
Entity type:Individual
Prefix:
First Name:MUKTAR
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LAUREL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5285
Mailing Address - Country:US
Mailing Address - Phone:603-892-2621
Mailing Address - Fax:
Practice Address - Street 1:141 LAUREL ST APT 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5285
Practice Address - Country:US
Practice Address - Phone:603-892-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty